Healthcare Provider Details

I. General information

NPI: 1649080516
Provider Name (Legal Business Name): LAKISHIA R FREEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11806 RUTLAND AVE
CLEVELAND OH
44108-1538
US

IV. Provider business mailing address

15311 EDGEWOOD AVE
MAPLE HEIGHTS OH
44137-3903
US

V. Phone/Fax

Practice location:
  • Phone: 216-338-9097
  • Fax:
Mailing address:
  • Phone: 216-338-9097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number186671
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License NumberSA245164
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number002403
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: